Boston College OFFICE FOR SPONSORED PROGRAMS DEPARTMENTAL SUBAWARD INITIATION REQUEST FORM

advertisement
Boston College
OFFICE FOR SPONSORED PROGRAMS
DEPARTMENTAL SUBAWARD INITIATION REQUEST FORM
SECTION I: FUNDS REQUESTED/PERIOD OF PERFORMANCE/BACK-UP DOCUMENTATION
Project Number: __________
Subaward No. (TBD by OSP): _________
OSP Rep. ___________
SUBRECIPIENT Full Legal Name (no abbreviations): ______________________________________________________
Project Title: _____________________________________________________________________________________
Amount obligated (this action): $____________
Total Cost (if fully funded): $_________________
Period of Performance: START date ______________
END date: _____________________
ATTACHMENTS TO BE PROVIDED:
Check all that apply to this Subaward. Signature of the SUBRECIPIENT’S AUTHORIZED OFFICIAL must
accompany these attachments or any additional documents to follow.
a) __ Current Statement of Work
b) __Current Budget (matches anticipated funding and is broken out basic DIRECT and INDIRECT cost categories)
c) __Budget Justification
d) __Equipment justification included in Subrecipient budget costing $5,000 or more for individual item
e) __Federally Approved F&A Rate Agreement (if applied to the attached SUBRECIPIENT budget) OR other basis for IDC
rates (if not previously provided or if changed)
f) __Cost Sharing Obligation (if applicable) Amount committed $ ___________
g) __IRB Approval Letter, if not provided at proposal stage
h) __IACUC Approval Letter, if not provided at proposal stage
i) __Export Control Information Identified (if shared or produced by SUBRECIPIENT)
SECTION II: SUBRECIPIENT Contact Information
A. Administrative Point of Contact: ________________________________________________
B. Administrative Mailing Address: ___________________________________________________________
________________________________________________________________________________________
Phone: ______________________________Email: ______________________________
C. SUBRECIPIENT Principal Investigator Name: ___________________________________________
Phone: ________________________ Email: _________________________
SECTION III: BC Contact Information
A. BC Administering Department: ________________________________________
B. Dept. Business Contact Name: __________________________________________
Phone: __________________________ Email: ________________________
C. BC’s Lead Investigator Name: ________________________________________
Phone: __________________________ Email: ________________________
Last Modified 1/13/2013
SECTION IV: **PAYMENT AND REPORTING REQUIREMENTS
Invoicing:
[Check One: Cost Reimbursement or Fixed Price payment plan]
☐Cost Reimbursement (Reimburse actual costs as they are invoiced throughout period of performance)
(or)
☐Fixed Price (Pay fixed amounts in accordance with attached schedule showing deliverables, due dates, and
dollar amounts associated with each. Final Payment requires all proposed deliverables to be received by PI.)
*Technical:
Progress
Annual
Final
Due Dates: ________________
Due Dates: ________________
Due Date: _________________
*Reports are normally required 30-45 days prior to your submission date
**NOTE: Provide an explanation of any “unique” requirements or terms and conditions to be incorporated into this
Subaward Agreement in addition to “flow down” terms from the Prime Award.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
SECTION V: BUDGET INFORMATION FOR PI APPROVAL
(Check each item below to indicate Principal Investigator’s review and approval of SUBRECIPIENT’S proposed budget for
reasonableness, allowability, and allocability of the proposed scope of work.)
____ SALARIES/LEVEL OF EFFORT – Salaries and level of effort have been reviewed and appear to be reasonable given
the proposed scope of work.
____ EQUIPMENT - Equipment has been reviewed and appears to be reasonable and necessary given the proposed
scope of work.
____ TRAVEL - Travel has been reviewed and appears to be reasonable and necessary given the proposed scope of work.
____ SUBCONTRACTS - Subcontracting for external research or other services appear reasonable and necessary given
the proposed scope of work.
____ MATERIALS & SUPPLIES - Materials and supplies have been reviewed and appear reasonable given the proposed
scope of work.
____ MISCELLANEOUS DIRECT COSTS - All other direct costs have been reviewed and appear reasonable and necessary
SECTION VI: SOLE/SINGLE SOURCE (COMPLETE ONLY IF PRIME AWARD FROM SPONSOR TO BC IS A CONTRACT )*
___ SUBRECIPIENT selected without seeking competitive bids: (Attach sheet) Justify your selection of this provider based
on expertise, location, unique facilities, cost, etc.
___ SUBRECIPIENT selected using competitive bids: (Attach sheet to include the following): 1) Name and address of each
subcontractor submitting a bid 2) Total Cost proposed by each bidder 3) Reason for selection of current Subcontractor.)
* Please use Purchasing’s Sole Source Request Form
SECTION VII: PRINCIPAL INVESTIGATOR/AUTHORIZED DESIGNEE APPROVAL:
I have reviewed the technical and cost proposals for this SUBRECIPIENT and based upon my professional experience and
analysis of costs or prices proposed, find them to be appropriate, fair, and reasonable for the work to be done.
Signature ___________________________________________ Date _____________________________________
Last Modified 1/13/2013
Download